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OP-978 <br /> FedEx Ground 0112212021 <br /> Hazardous Material Donation and Reuse Distribution <br /> Acknowledgment of Receipt <br /> If you need assistance in filling out this form, please contact the Environmental Affairs department. <br /> C <br /> Note: Only the facility senior manager can sign this document. <br /> }'!,�2 X00 _ ("We"enter recipient name)hereby acknowledge receipt <br /> of the following product(s)with tbb full understanding of their origin(i.e.,part of a damaged package shipment). We <br /> have been advised that the material(s)constitute hazardous substances under federal and state laws and must be <br /> used in accordance with its intended use end purpose. We will properly dispose of empty containers) or remaining <br /> materials(s)in accordance with applicable regulations.Upon taking possession of these products)we ag ree to fully <br /> release and indemnify FedEx Ground Package System, Inc.("FedEx Ground")from any Iiabilityarising from the use of <br /> these materials(s)excluding tax liability. <br /> Product(s) received: <br /> IMPORTANT: An eligible donation or reuse distribution is items that have been evaluated as either a hazardous material or Limited <br /> Quantify. items not evaluated as a hazardous material or Limited Quantity must be sent to OVERGOODS. <br /> INSTRUCTIONS: Plane an 'X'in the category and include a description for each container donated for reuse distribution. Be sure to <br /> indicate whether the i em(s) is/are hazardous material or Limited Quantity. Keep a copy for your retards and a copy for the recipient. <br /> I_lHAZARDOUS MATERIAL OR LIMITED QUANTITY ITEM QUANTITY &TYPE OF CONTAINER <br /> o TYPE OF <br /> M 0. ~I CONTAINER <br /> Zr M <br /> oI AMOUNT (cern, b—,drum, <br /> u�',. �• 1+ _� DESCRIPTION #OF ITEMS i5ul,az,Ih,etc.) pail,etc.) I <br /> i' a al a <br /> ± _. D _.._.— Q . _- _st_ c7?__ <br /> 7 S- <br /> C_ ►D rox <br /> 1 a5C___. <br /> .........5..o..Fie n .�__-___1C _o_,Z <br /> AMMUNITION NOTE: Only facilities in AK & NI are to donate ammunition to authorized enforcement agencies. All other facilities <br /> must send their ammunition to Overgoods.if you are one of the facilities that are authorized to donate, attach a copy of the <br /> recipient's identification (i.e. badge, license, etc.)to this form and retain a copy for your records. <br /> TP ,- 0, l .• S3 1-151 a Ol 0l5 Z <br /> Facility Alpha Code/Number Recipient Address <br /> 292ca (z__1 k t <br /> F round Facility Seni anagerf ted Name cipient Printed Name <br /> FedEx G ; <br /> ac' tySeniorManagerS' nature Mdcipi <br /> ntSignature <br /> d� °L 2 � <br /> Date Date <br /> Reference: Waste Minimization Plan,ENV-702 <br />